Lee Young-Kyun, Yoon Byung-Ho, Hwang Ji Sup, Cha Yong-Han, Kim Ki-Choul, Koo Kyung-Hoi
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea.
Injury. 2018 Mar;49(3):691-696. doi: 10.1016/j.injury.2018.02.009. Epub 2018 Feb 10.
Basicervical femur neck fracture (FNF) is a rare type of fracture, and is associated with increased risk of fixation failure due to its inherent instability. The purpose of this study was (1) to investigate the incidence of fixation failure and (2) to determine risk factors for fixation failure in basicervical FNF after internal fixation.
To identify basicervical FNF with a minimum of 12 months follow-up, we retrospectively reviewed records of 3217 patients who underwent hip fracture surgery from May 2003 to March 2016. Among the identified 77 patients with basicervical FNF, 69 patients were followed up for at least 12 months. We evaluated the rate of collapse of fracture site and reoperation due to fixation failure. We performed a multivariable analysis to determine risk factors associated with fracture site collapse and fixation failure.
Among the 69 patients with basicervical FNF, 17 (24.6%) showed collapse of fracture site, and 6 (8.6%) underwent conversion to arthroplasty because of fixation failure. In the multivariable analysis, use of extramedullary plating with a sliding hip screw was an independent significant risk factor for both collapse of fracture site (odds ratio 6.84; 95% confidence interval 1.91-24.5, p = 0.003) and fixation failure (odds ratio 12.2; 95% confidence interval 1.08-137.7, p = 0.042).
Basicervical FNF treated with extramedullary plate with a sliding hip screw is more likely to fail than that treated with intramedullary nail with a helical blade. Our results suggested that intramedullary nail with a helical blade is more recommended for basicervical FNF compared with extramedullary plate with a sliding hip screw.
III, Retrospective cohort study.
股骨颈基底部骨折（FNF）是一种罕见的骨折类型，因其固有的不稳定性，内固定失败风险增加。本研究的目的是：（1）调查内固定失败的发生率；（2）确定股骨颈基底部骨折内固定后固定失败的危险因素。
为了识别随访至少12个月的股骨颈基底部骨折患者，我们回顾性分析了2003年5月至2016年3月期间接受髋部骨折手术的3217例患者的记录。在确诊的77例股骨颈基底部骨折患者中，69例患者接受了至少12个月的随访。我们评估了骨折部位塌陷率和因固定失败而再次手术的情况。我们进行了多变量分析，以确定与骨折部位塌陷和固定失败相关的危险因素。
在69例股骨颈基底部骨折患者中，17例（24.6%）出现骨折部位塌陷，6例（8.6%）因固定失败而改行关节置换术。在多变量分析中，使用带滑动髋螺钉的髓外钢板是骨折部位塌陷（比值比6.84；95%置信区间1.91 - 24.5，p = 0.003）和固定失败（比值比12.2；95%置信区间1.08 - 137.7，p = 0.042）的独立显著危险因素。
与使用带螺旋刀片的髓内钉治疗相比，使用带滑动髋螺钉的髓外钢板治疗股骨颈基底部骨折更易失败。我们的结果表明，与带滑动髋螺钉的髓外钢板相比，带螺旋刀片的髓内钉更推荐用于治疗股骨颈基底部骨折。
III，回顾性队列研究。
